recovery: joint replacement surgery

When arthritis wears away a knee or hip joint surface, the area can become inflamed and swollen. Muscles around the joint become weaker; pain and stiffness may even cause you to walk with a limp.

Don’t wait until you can no longer stand the pain, cautions Steven B. Zelicof, M.D., Ph.D., joint reconstruction specialist at Specialty Orthopaedics in Harrison, citing the risk of surgical failure at about one percent each year. “When it comes time that you’re uncomfortable because of a painful knee or hip joint, often times the earlier you get it taken care of, the better you’ll do.”

PREPARING VIA PREHAB
The better your condition prior to surgery, the better your post-surgical recovery and rehab will be. Zelicof favors prehab, which is physical therapy before surgery. “This gets people into a mindset of having surgery,” he says.

Chris Dal Ceredo, a physical therapist and director of the orthopedic program at Burke Rehabilitation Hospital, notes the two biggest predictors of patient success is his/her level of activity before surgery and age. When you’re active and your body is conditioned to do regular exercise, the physical activity won’t be foreign to you when you get to rehab.

READY, SET, MOVE!
Now that you’ve got a new artificial joint, the sooner you use it, the less chance it will become stiff. Physical rehabilitation at home, after surgery, can aid mobility so the new joint will have a greater range of motion – even before the patient goes to out-patient physical therapy.

Physical therapy helps with range of motion, daily functioning, and strength and stability; however, it should be tailored to a patient’s specific diagnosis, explains Dr. Allen Wilkins, a physiatrist who treats patients with physical medicine and rehabilitation at Millennium Medical and Rehab in Scarsdale. “For example, if a patient has hip pain, the more detailed the diagnosis, the more targeted the physical therapy, the better the outcome.”

The simple daily activities of walking and moving are great for recovery, says Zelicof. He points out that, “Getting into bed, getting up from the couch and moving in your home are all physical therapy.” And it’s important to start moving early on, “If it’s physical, then it’s therapy,”

APPROACHES DETERMINE EXERCISE
As there are no industry standards for joint replacement rehab, the recovery process is based upon a person’s own health and build, condition, and the surgical approach (how the joint was reached). But the professionals agree that the more mobile a person is after surgery, the better the outcome.

Since not all physical therapists have the same training and specialties, it’s important to find one who is knowledgeable about the different approaches. Doctors will prescribe physical therapy but leave the modalities to the therapist’s clinical judgment.

Patients who have had an anterior (front of hip) approach for their hip surgery usually have no precautions, notes Dal Ceredo, while patients who’ve undergone a posterior (back of hip) approach are instructed in hip precautions as there’s a greater risk of dislocation. These include not moving beyond a 90-degree angle (i.e., tying shoelaces) for the first few months; not crossing the operated leg – the leg attached to the new hip joint – over the non-operated leg and not pointing the operated leg’s foot toward the other foot.

REALISTIC GOALS
Since post-surgery healing can be affected by many things, Millenium’s Wilkins advises it’s best to discuss options with your surgeon to see if a new joint or another option is the right choice for you.

Joint replacements may take six months to one year to become part of you, says Zelicof. He advises patients not to compare their recoveries to others. “Every patient is different.” So, listen to your body and, when in doubt, check with your surgeon.

Author’s Note: The morning after my total left hip joint replacement, I put my new, limp-free gait to the test with a walker and the physical therapist, exhilarated that the familiar pain was gone. I wish you the same joy and healing.

 

Hip and Knee Joint Replacement
Myth V. Fact

Myth: There is no swelling right after surgery.

Fact: Swelling is the body’s natural response to injury; after surgery, it’s expected and normal. While drinking water and exercising muscles seem like counterintuitive thinking, they can help the body expel extra water.

Myth: Everyone gets home care.

Fact: Some doctors send patients home and tell them to simply walk. Therapy can be done at home;  however, patients have access to more modalities like ice, exercise machines, mats and massage tables at out-patient clinics.

Myth: The new joint will not support body weight so you’ll need to spend time in bed.

Fact: People are encouraged to move as much as possible and be mindful of precautions after surgery. Moving right away helps with healing, prevents blood clots from forming, and also benefits digestion and breathing.